Provider Demographics
NPI:1891749347
Name:RUNDLE, SCOTT A (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:RUNDLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 HOSPITAL WAY
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-7849
Mailing Address - Country:US
Mailing Address - Phone:406-863-3500
Mailing Address - Fax:406-862-2510
Practice Address - Street 1:1600 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-7849
Practice Address - Country:US
Practice Address - Phone:406-863-3500
Practice Address - Fax:406-862-2510
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9553207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT152711Medicaid
MT93176OtherBLUE CROSS
H29918Medicare UPIN
MT85252Medicare ID - Type Unspecified